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Merck Manual

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Spotlight on Aging

Spotlight on Aging

The main reason older women give up on sex is lack of a sexually functional partner. However, age-related changes, particularly those due to menopause, can make women more likely to experience sexual dysfunction. Also, disorders that can interfere with sexual function, such as diabetes, atherosclerosis, urinary tract infections, and arthritis, become more common as women age. However, these changes need not end sexual activity and pleasure, and not all sexual dysfunction in older women is caused by age-related changes.

In older women as in younger women, the most common problem is low sexual desire.

As women age, less estrogen is produced.

  • The tissues around the vaginal opening (labia) and the walls of the vagina become less elastic and thinner (a disorder called atrophic vaginitis), This change can cause pain during sexual activity that involves penetration.

  • Vaginal secretions are reduced, providing less lubrication during sexual intercourse.

  • Less and less testosterone is produced starting when women are in their 30s and stopping by about age 70. Whether this decrease leads to decreased sexual interest and response is unclear.

  • The acidity of the vagina decreases, making the genitals more likely to become irritated and infected.

  • Lack of estrogen may contribute to age-related weakening of muscles and other supportive tissues in the pelvis, sometimes allowing a pelvic organ (bladder, intestine, uterus, or rectum) to protrude into the vagina. As a result, urine may leak involuntarily, causing embarrassment.

  • With aging, blood flow to the vagina is reduced, causing it to become shorter, narrower, and drier. Blood vessel disorders (such as atherosclerosis) can reduce blood flow even more.

Other problems may interfere with sexual function. For example, older women may be distressed by changes in their body caused by disorders, surgery, or aging itself. They may think that sexual desire and fantasy are improper or shameful at an older age. They may be worried about the general health or sexual function of their partner or their own sexual performance. Many older women have sexual desire, but if their partner no longer responds to them, their desire may be slowly extinguished.

Older women should not assume that sexual dysfunction is normal for older age. If sexual dysfunction is bothering them, they should talk to their doctor. In many cases, treating a disorder (including depression), stopping or substituting a drug, learning more about sexual function, or talking to a health care practitioner or counselor can help.

If atrophic vaginitis is a problem, estrogen can be inserted into the vagina as a cream (with a plastic applicator), as a tablet, or in a ring. Estrogen may be taken by mouth or applied in a patch or gel to an arm or a leg but only if menopause occurred recently. Occasionally, testosterone is prescribed in addition to estrogen therapy if all other measures are ineffective, but prescribing this combination is not recommended. It is still considered experimental and long-term safety is unknown.